Pathological staging of muscle invasive bladder cancer: is substaging of pT2 tumors really necessary?

OBJECTIVE: Compare clinical outcomes in patients having urothelial tumors invading less than one half of the depth of bladder muscle and greater than one half of bladder muscle and, to determine various clinical variables as predictive factors for survival. MATERIALS AND METHODS: According to our inclusion criteria, 57 patients among cases with T2 bladder tumor were selected. Thirty-five patients (61.4 %) had pT2a (Group-1) and 22 patients (38.6%) had pT2b (Group-2) muscle invasive tumors. Mean follow up time was 7.3 years for Group-1, and 6.1 years for Group-2. Multivariate analysis was performed in order to identify possible correlation of clinical variables like age, gender, grade of primary tumor, appearance of local and/ or distant metastasis with patient outcome. RESULTS: Five year recurrence-free and overall survival rates were 69.1% and 44.3% for patients with pT2a tumor, whereas these ratios were 66.1% and 43%, respectively for patients with pT2b tumor (p = 0.896; p = 0.975). Mean overall and progression-free survival times were 87.7 ± 13.8 and 116 ± 13.12 months for Group-1, while they were 73.8 ± 13.7 and 88.85 ± 12.55 months for Group-2, respectively. On both univariate and multivariate analysis, age was noticed as an independent predictive factor for survival. CONCLUSIONS: The depth of muscle invasion in bladder tumors has no prognostic significance. Recurrence of the disease either locally or at distant sites dramatically shortens patients' life. Being older than 60 years old during the time of radical surgery, is also a bad prognostic factor for overall and progression-free survival

Public awareness of testicular cancer and self-examination in Turkey: A multicenter study of Turkish Urooncology Society

WOS: 000317169500016PubMed ID: 21429771Background: Testicular self-examination is the easiest and cheapest way to scan testicular cancer. However, the public awareness about testicular self-examination is very low. We aimed to investigate the public awareness of Turkish people about testicular cancer and testicular self-examination. Methods: We performed a survey consisting of 10 questions concerning testicular cancer and testicular self-examination in 799 students in the first year of 12 different medical schools. Aiming for a common method of data collection, the questionnaires were administered to the students during a class just before the lesson started. The whole data from all of the centers were pooled in a common data-base file. Results: Eighty-nine (11.1%) of the participants reported that they had knowledge about testicular cancer, but only 11(1.4%) of them answered all the questions about testicular cancer correctly. Eight (1%) of the participants reported that they had been performing testicular self-examination routinely once a month. Four (0.5%) of them were both well informed about testicular cancer and had been performing testicular self-examination once a month as suggested. Conclusion: The present study showed that awareness on testicular cancer and testicular self-examination is very low and suggests a need for efforts in Turkey to increase public awareness and education. (C) 2013 Elsevier Inc. All rights reserved

Reliability of frozen section examination of obturator lymph nodes and impact on lymph node dissection borders during radical cystectomy: results of a prospective multicentre study by the Turkish Society of Urooncology

WOS: 000286767300006PubMed ID: 20633004What's known on the subject? and What does the study add? The anatomic extent of lymphadenectomy to achieve both goals, namely accurate staging and potential curative role, in bladder carcinoma patients is still in debate. We aimed in this study to evaluate the accuracy of frozen section examination (FSE) for detecting lymph node (LN) metastases and whether we can use this information to decide the extent of LN dissection during cystectomy. As a conclusion, we think that in such cases performing FSE only at obturator regions will give the information of possibility of residual positive LNs and the surgeon will then decide whether or not it is worthwhile in that case to proceed with EPLND. OBJECTIVE To evaluate the accuracy of frozen section examination (FSE) for detecting lymph node (LN) metastases and whether we can use this information to decide the extent of LN dissection during cystectomy. PATIENTS AND METHODS From August 2005 to August 2009 FSE of obturator LNs was performed in 118 patients with bladder cancer, who were undergoing radical cystectomy with extended LN dissection. Removed tissues from 12 well defined LN regions were sent separately for pathologic evaluation. The FSE results of obturator regions were compared with the final histopathologic results of these node regions. RESULTS The mean number of removed nodes per patient was 29.4 +/- 9.3 (median 28, range 12 to 51). The sensitivity, specificity, positive and negative predictive values of FSE for the 118 right obturator LN regions were 94.7%, 100%, 100% and 99%, respectively. The same values for the 118 left obturator LN regions were 86.7%, 100%, 100% and 98.1%, respectively. At final pathologic examination 28 of 118 (23.7%) patients had LN metastasis at obturator regions. Skipped metastasis was found in 15/90 patients (16.7%). Clinical and pathological stage of the primary tumour were found to be significant parameters for skipped metastasis (P = 0.008 and P < 0.001, respectively). CONCLUSIONS Performing FSE of the obturator LNs seems to be a reliable procedure for their evaluation with acceptable negative and positive predictive values. The information obtained with FSE of obturator LNs can be used to determine intraoperatively the extent of LN dissection, especially in patients with significant comorbidity. Our study also showed that if the clinical stage of the primary tumour is < cT2, the possibility of skipped metastasis is zero

Public awareness of testicular cancer and self-examination in Turkey: A multicenter study of Turkish Urooncology Society

Background: Testicular self-examination is the easiest and cheapest way to scan testicular cancer. However, the public awareness about testicular self-examination is very low. We aimed to investigate the public awareness of Turkish people about testicular cancer and testicular self-examination. Methods: We performed a survey consisting of 10 questions concerning testicular cancer and testicular self-examination in 799 students in the first year of 12 different medical schools. Aiming for a common method of data collection, the questionnaires were administered to the students during a class just before the lesson started. The whole data from all of the centers were pooled in a common data-base file. Results: Eighty-nine (11.1%) of the participants reported that they had knowledge about testicular cancer, but only 11 (1.4%) of them answered all the questions about testicular cancer correctly. Eight (1%) of the participants reported that they had been performing testicular self-examination routinely once a month. Four (0.5%) of them were both well informed about testicular cancer and had been performing testicular self-examination once a month as suggested. Conclusion: The present study showed that awareness on testicular cancer and testicular self-examination is very low and suggests a need for efforts in Turkey to increase public awareness and education. © 2013 Elsevier Inc

A prospective randomized multicenter study of Turkish Society of Urooncology comparing two different mechanical bowel preparation methods for radical cystectomy

WOS: 000321597600023PubMed ID: 21546277Objective: To investigate the outcomes and complication rates of urinary diversion using mechanical bowel preparation (BP) with 3 day conventional and limited BP method through a standard perioperative care plan. Materials and methods: This study was designed as a prospective randomized multicenter trial. All patients were randomized to 2 groups. Patients in standard 3-day BP protocol received diet restriction, oral antibiotics to bowel flora, oral laxatives, and saline enemas over a 3-day period, whereas limited the BP arm received liberal use of liquid diet, sodium phosphate laxative, and self administered enema the day before surgery. All patients received same perioperative treatment protocol. The endpoints for the assessment of outcome were anastomotic leakage, wound infection, wound dehiscence, intraperitoneal abscess, peritonitis, sepsis, ileus, reoperation, and mortality. Bowel function recovery, including time to first bowel movement, time to first oral intake, time to regular oral intake, and length of hospital stay were also assessed. Results: Fifty-six patients in 3-day BP and 56 in limited BP arm were evaluable for the study end points. Postoperatively, 1 patient in limited BP and 2 patients in 3-day BP arm died. There was no statistical difference in any of the variables assessed throughout the study, however, a favorable return of bowel function and time to discharge as well as lower complication rate were observed in limited BP group. Conclusions: Regarding all endpoints, including septic and nonseptic complications, current clinical research offers no evidence to show any advantage of 3-day BP over limited BP. (C) 2013 Elsevier Inc. All rights reserved

Extended Pelvic Lymph Node Dissection: Before Or After Radical Cystectomy? A Multicenter Study Of The Turkish Society Of Urooncology

Purpose We aimed to ascertain the effects of performing extended pelvic lymph node dissection (PLND) on the duration of surgery, morbidity, and the number of lymph nodes removed when the dissection was performed before or after radical cystectomy (RC). Materials and Methods We used the database of our previous prospective multicenter study. A total of 118 patients underwent RC and extended PLND. Of the 118 patients, 48 (40.7%) underwent extended PLND before RC (group 1) and 70 (59.3%) underwent extended PLND after RC (group 2). The two groups were compared for extended PLND time, RC time, and total operation times, per operative morbidity, and the total numbers of lymph nodes removed. Results Clinical and pathologic characteristics were comparable in the two groups (p>0.05). The mean RC time and mean total operation times were significantly shorter in group 1 than in group 2 (p<0.001). The mean number of lymph nodes removed was 27.31±10.36 in group 1 and 30.87±8.3 in group 2 (p=0.041). Only at the presacral region was the mean number of lymph nodes removed significantly fewer in group 1 than in group 2 (p=0.001). Intraoperative and postoperative complications and drain withdrawal time were similar in both groups (p=0.058, p=0.391, p=0.613, respectively). Conclusions When extended PLND was performed before RC, the duration of RC and consequently the total duration of the operation were significantly shorter than when extended PLND was performed after RC. Practitioners may consider performing extended PLND before RC and rechecking the presacral area for additional lymph nodes after RC, particularly in elderly patients with high co-morbidity for whom the duration of surgery matters.PubMedScopu